Early Weight Gain Predicts Retinopathy in Preterm Infants: New, Simple, Efficient Approach to Screening
Early Weight Gain Predicts Retinopathy in Preterm Infants: New, Simple, Efficient Approach to Screening
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DOI：
10.1542/peds.2008-2697
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发表时间：
2009-04-01
期刊：
影响因子：
8
通讯作者：
Lofqvist, Chatarina
中科院分区：
文献类型：
--
作者：
Hellstrom, Ann;Haerd, Anna-Lena;Lofqvist, Chatarina
背景通过胎龄和/或出生时体重预测早产儿视力威胁性视网膜病变的风险。所有低于阈值的婴儿都要接受一系列眼科检查，以确定哪些婴儿会从治疗中获益（类似于10%）。我们假设，考虑到出生后体重增加，可以更早更特异地识别出威胁视力的早产儿视网膜病变的风险。从出生到月经后第36周的每周体重被回顾性地输入到一个监测系统中，当体重增加率下降到一定水平时，该系统会发出警报。对于2004-2007年在Sahlovenska大学医院筛查和/或治疗早产儿视网膜病变的所有儿童（N = 354），记录每周体重。一名儿童因已知的非生理性体重增加（脑积水）而被排除。结果对于353名儿童中的127名（36%），未发出警报;对于40%的儿童，在月经后第32周后发出低风险警报。这些儿童均未发生需要治疗的早产儿视网膜病变。其余24%的儿童在月经后32周前收到高或低风险警报，41%发生早产儿增殖性视网膜病变，29%因视力威胁疾病接受治疗。从报警到治疗的中位时间为9周。体重、胰岛素样生长因子、新生儿早产儿视网膜病变算法早期检测到100%的需要治疗的早产儿视网膜病变，并正确预测了大多数不需要治疗的婴儿。通过这种简单的产后评估，可以显着减少昂贵的压力性眼科检查（类似于75%的婴儿）。此外，早期识别有风险的儿童可能会导致干预措施的启动，并可能预防危及视力的早产儿视网膜病变。儿科2009; 123：e638-e645
BACKGROUND. The risk for sight-threatening retinopathy of prematurity is predicted by using gestational age and/or weight at birth. All infants below a threshold undergo serial ophthalmologic examinations for identification of those who would benefit from treatment (similar to 10%). We hypothesized that factoring in postnatal weight gain could identify children at risk for sight-threatening retinopathy of prematurity more specifically and earlier.METHODS. Weekly weights from birth to postmenstrual week 36 were retrospectively entered into a surveillance system that gave an alarm when the rate of weight gain decreased to a certain level. For all children (N = 354) screened and/or treated for retinopathy of prematurity at Sahlgrenska University Hospital in 2004-2007, weekly weights were recorded. One child was excluded because of known nonphysiologic weight gain (hydrocephalus). RESULTS. For 127 (36%) of 353 children, no alarm was given; for 40%, alarm at low risk was given after postmenstrual week 32. None of those children developed retinopathy of prematurity requiring treatment. Of the remaining 24% of children who received alarm at high or low risk before 32 postmenstrual weeks, 41% developed proliferative retinopathy of prematurity and 29% were treated because of sight-threatening disease. The median time from alarm to treatment was 9 weeks.CONCLUSIONS. The weight, insulin-like growth factor, neonatal retinopathy of prematurity algorithm detected early 100% of infants who developed retinopathy of prematurity requiring treatment and correctly predicted the majority who did not require treatment. With this simple postnatal evaluation, costly stressful eye examinations can be markedly reduced (similar to 75% of infants). In addition, early identification of children at risk may lead to the initiation of interventions and possibly prevent sight-threatening retinopathy of prematurity. Pediatrics 2009; 123: e638-e645